Body composition, physical performance and muscle quality of active elderly women

doi:10.1016/j.archger.2014.02.004

Archives of Gerontology and Geriatrics

Volume 59, Issue 1, July–August 2014, Pages 44-48

https://doi.org/10.1016/j.archger.2014.02.004 Get rights and content

Abstract

Fat gain is one of the major factors aggravating physical disability in the elderly population, which presents an increase in fat mass and a decrease in lean mass compared to the young population. For this reason it is important to assess body composition and the effects of these alterations in obese elderly women. The purpose of this study was to assess body composition, physical performance and muscle quality in active elderly women. Cross-sectional study included 75 elderly women (29 eutrophic and 46 obese) 65–80 years old. Body composition was evaluated by dual energy X-ray absorptiometry (DXA) and the physical performance was determined by 6-minute walk test (6MWT), handgrip strength (HS) and knee extension strength (KES). Muscle quality was calculated as the ratio between muscle strength and lean mass. Fat free mass, lean mass, fat mass and percent body fat were significantly higher in the obese group (p < 0.05). Furthermore, the obese group showed a poorer performance than the eutrophic group in the 6MWT (432.31 ± 66.13 m and 472.07 ± 74.03 m, respectively, p = 0.01). HS and KES did not differ between groups, however, regarding muscle quality, the obese group exhibited a impaired in comparison to the eutrophic group in the upper (11.45 ± 2.57 kg and 13.31 ± 2.03 kg, respectively, p < 0.01) and lower limb (2.91 ± 1.16 kg and 3.44 ± 0.97 kg, respectively, p = 0.05). The increase in muscle mass detected in the obese elderly was not sufficient to maintain adequate muscle quality and physical function, showing a negative influence of the excess of body fat.

Introduction

Approximately 1.0 billion adults are currently overweight, and a further 475 million are obese (IOTF, 2010). The accumulation of adipose tissue in the organism is directly or indirectly related to pathological situations that contribute to morbidity–mortality, such as arterial hypertension, dyslipidemia, ischemic coronary disease and osteoarticular and neoplastic diseases. Nowadays, the prevalence of obesity is higher among women (Bouchard, Soucy, Sénéchal, Dionne, & Brochu, 2010) and also among the elderly (Sulander, Rahkonem, Helakorpi, Nissinen, & Vutela, 2004).

Obesity is one of the major factors aggravating physical disability in the elderly population, being that women report more limitations at all ages than men (Bouchard et al., 2010). This fact is possibly due to the large amount of fat mass (FM) accumulating in this population associated with a sedentary life style, factors frequently associated with functional disability (Rolland et al., 2004, Villareal et al., 2004).

The percentage of fat free mass (FFM) and bone mass of adult obese individuals tends to be higher than in eutrophic individuals and this modification of body composition is believed to be an adaptation to the increased body weight imposed on the physical structure of an individual (Baumgartner et al., 2004). According to Newman et al. (2003) this adaptation may be beneficial since obese elderly with increased FFM may have less difficulty in performing their daily activities than obese subjects with a reduction of FFM quantity, known as sarcopenia.

However, it cannot be stated whether this increase in FFM among obese elderly subjects will reflect on muscle quality (MQ), which is defined as muscle strength divided by the lean mass of an individual. What needs to be clarified is whether this increase in lean mass will provide improved muscle strength and quality (Barbat-Artigas et al., 2012a, Rolland et al., 2004).

Obesity may have important functional implications in elderly persons because it worsens the age-related decline in physical function, which can lead to frailty and dependence (Villareal et al., 2004). However, the mechanisms responsible for the physical disability of obese elderly have not been fully identified (Rolland et al., 2004). Furthermore, until recently, obesity was thought to protect skeleton from osteoporosis and that adipose tissue accumulation insulate bone. However, recent data showed a high rate of bone fracture in obese postmenopausal women. Thus, it is important to conduct studies that will estimate body composition, physical performance and muscle strength in obese elderly, to support in the development of therapeutic strategies aimed at this population.

On this basis, the purpose of this study was to assess and to compare body composition, fat mass distribution, physical performance and muscle quality of active elderly women.

Section snippets

Study design, recruitment and participants

A cross-sectional observational study was conducted at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRP-USP). The study was approved by the Research Ethics Committee of the Institution (protocol HCRP no. 12152/2007), according to the requirements of resolution no. 196/96 of the National Health Council. All volunteers were informed about the objectives and operational procedures of the study and about guaranteed preservation of anonymity and gave

Results

Seventy-five female volunteers older than 65 years were selected to participate in the study and were divided into two groups based on the %BF assessed by DXA. Elderly women with % BF of 38 or more were considered obese. Twenty-nine women with % BF lower than 38%, aged 65–80 years, were classified as eutrophic, and 46 women with %BF ≥ 38%, aged 65–79 years, were classified as obese.

Table 1 shows the participant demographics, anthropometric and body composition data. In addition, the eutrophic and

Discussion

The results of the present study indicate that, although the active obese women had a greater quantity of FFM and lean mass, these characteristics were not sufficient to maintain adequate physical function, suggesting that excess body fat had a negative influence on the physical performance of this group, even this group being physically active.

In the present study we opted to divide the obese and eutrophic groups based on %BF since the elderly are known to present changes in body composition

Author contributions

K.H.C. Vilaça: Conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article.

J.A.O. Carneiro: Data collection, data analysis, article revision.

E. Ferriolli, N.K.C. Lima and F.J.A. Paula: Data analysis, article revision.

J.C. Moriguti: Research design, data collection, data analysis, article writing and revision.

Conflict of interest statement

None.

Acknowledgment

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP – Grant number: 08/53125-7).

References (27)

S. Barbat-Artigas et al.
How to assess functional status: A new muscle quality index
Journal of Nutrition, Health and Aging
(2012)
P.L. Enright et al.
The 6-min walk test: A quick measure of functional status in elderly adults
Chest
(2003)
Y. Rolland et al.
Muscle strength in obese elderly women: Effect of recreation physical activity in a cross-sectional study
American Journal of Clinical Nutrition
(2004)
K.H.C. Vilaça et al.
Body composition assessment of undernourished older subjects by dual-energy X-ray absorptiometry and bioelectric impedance analysis
Journal of Nutrition Health and Aging
(2011)
American Thoracic Society Statement
Guidelines for the six-minute walk test
American Journal of Respiratory and Critical Care Medicine
(2002)
S. Barbat-Artigas et al.
Muscle quality as a potential explanation of the metabolically healthy but obese and sarcopenic obese paradoxes
Metabolic Syndrome and Related Disorders
(2012)
R.N. Baumgartner et al.
Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly
Obesity Research
(2004)
D.R. Bouchard et al.
Changes in objective and self-reported measures of physical capacity after an intervention in obese older women
Journal of Women and Aging
(2010)
B.C. Clark et al.
Sarcopenia ≠ Dynapenia
Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
(2008)
C.L. Craig et al.
International physical activity questionnaire: 12 country reliability and validity
Medicine and Science in Sports and Exercise
(2003)

M. Estrada et al.

Functional impact of relative versus absolute sarcopenia in healthy older women

Journal of the American Geriatrics Society

(2007)

E.E. Fess

Grip strength

W.R. Frontera et al.

A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women

Journal of Applied Physiology

(1991)

Cited by (35)

Muscle Quality in Older Adults: A Scoping Review
2023, Journal of the American Medical Directors Association
This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults.
Scoping review.
All available studies.
Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years.
A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%).
There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of “skeletal muscle health” in older adults.
Associations between physical activity levels with nutritional status, physical fitness and biochemical indicators in older adults
2021, Clinical Nutrition ESPEN
Citation Excerpt :
In this regard, regular physically active women had considerably better mobility and performed approximately 14 % longer distance during the 6MWT compared to inactive women [45]. Vilaça et al. reported that total distance in 6MWT has been related to the difficulty of performing daily activities [63]. Besides, it has been shown VO2peak was estimated to reduction of 6.9 and 3.9 ml kg-1-min-1 per decade in men and women, respectively [64,65].
A sedentary lifestyle is one of the major health concerns of all societies that is associated by an increased risk of cardiovascular diseases. In this regard, we compared the anthropometric parameters, physical fitness (PF), lipid profile, and nutritional status of older adults with different levels of physical activity (PA).
In this cross sectional study, 220 older people (age: 67.39 ± 2.08 yrs) according to their PA levels had been categorized at high (n = 72), moderate (78) and low (n = 70) PA groups. The International Physical Activity Questionnaires and food frequency questionnaire has been used to determine the PA and nutritional status, respectively. Waist and hip circumference, height, weight, and body mass index of subjects were measured and calculated. Both lower and upper body strength, flexibility, static and dynamic balance, and endurance performance factors were used to determine the level of PF. To assess blood biochemical factors, subjects were asked to visit the laboratory after 12 h of fasting.
The results showed waist circumference, hip circumference, and body fat percent were significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Upper body strength, lower body strength, static balance, dynamic balance flexibility and endurance were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Moreover, triglyceride was significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). According to the post hoc results, high-density lipoprotein, low-density lipoprotein and fasting glucose were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). All participants regardless PA levels showed insufficient consumption of zinc, calcium, vitamin E, and vitamin D (P ≤ 0.05). On the other hand, carbohydrate, sodium, iron, vitamin C and niacin intake significantly above recommended dietary allowance (P ≤ 0.05).
The results of the current work showed that a higher level of PA improved anthropometric indicators, PF, and lipid profile in Iranian older adults. Moreover, older nutrition should be monitor to maintain their physical health and to prevent them from developing chronic diseases and their malnutrition complications.
Obesity and falls in older women: Mediating effects of muscle quality, foot loads and postural control
2020, Gait and Posture
Citation Excerpt :
Lower-limb muscle function is a well-established risk factor for falls and thus its evaluation has been emphasized in older people [7]. In accordance with a previous report [8], obese older women exhibit greater leg lean mass, but not muscle strength; and as a consequence specific torque is reduced. It has been shown that muscle mass appears to be associated with bodyweight, probably because gravity and inertial forces during movement stimulate mechanoreceptors that modulate the production of growth factors [23].
Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk.
Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older?
At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05.
204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39–3.27). Using the counterfactual approach, only specific torque (NIE: 1.11, 95 % CI: 1.01–1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01–1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively.
Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population.
Association between body composition and inflammation: A central role of IL-17 and IL-10 in diabetic and hypertensive elderly women
2019, Experimental Gerontology
Citation Excerpt :
Besides fat mass, several works have associated the low amount of muscle mass in elderlies with insulin resistance, metabolic syndrome, and diabetes risk (Lim et al., 2010; Srikanthan et al., 2010; Srikanthan and Karlamangla, 2011). In this regard, although Vilaça et al. (2014) have observed that the amount of lean mass (kg) is higher in obese women, we found in our study that the percentage amount of lean mass was higher in eutrophic patients when compared to overweight women. A recent study demonstrated that the low percentage of lean mass in women (<24.96%) was associated with a higher prevalence of diabetes and hypertension as well as a higher incidence of pathophysiological changes resulting from them, such as increased serum glucose concentration, insulin resistance, and higher systolic and diastolic blood pressures independently of fat mass (Son et al., 2017).
In women, aging is evidenced by physiological hormonal alterations that trigger changes in body composition, emergence of chronic low-grade inflammation, which is an important pre-disposition to the development of chronic diseases such as Systemic Arterial Hypertension (SAH) and Type 2 Diabetes Mellitus (T2DM). Although it is a strong pro-inflammatory nature disorder, little is known about how body composition interferes with inflammatory markers in diabetic and hypertensive elderly women. Therefore, this study's objective was to evaluate the inflammation in diabetic and hypertensive elderly women, and their association with fat mass. It comprised the evaluation of 144 women aged between 60 and 80 years old, diagnosed with SAH and T2DM, assisted by Family Health Units in Vitória da Conquista, Bahia, Brazil. According to body mass index (BMI), these women were classified as either eutrophic or overweight. In the eutrophic females, the IL-10 / IL-17A ratio was increased when compared to those overweight. In addition, IL-17 correlated negatively with HDL and positively with total cholesterol, LDL, triglycerides, VLDL, and glucose in the eutrophic ones, but not in the overweight individuals. IL-10 also showed differences in the correlation pattern observed between the groups, since for this eutrophic cytokine, it presented positive correlation with the waist circumference, waist/height ratio, and negative association with IL-17, while in overweight elderly women, it was not observed such pattern. Hence, this work demonstrates how the amount of fat mass interferes with the balance of cytokines, especially IL-10 and IL-17, and how it may exert an effect on biochemical parameters and risk factors associated with T2DM and SAH.
Associations of distinct levels of physical activity with mobility in independent healthy older women
2018, Experimental Gerontology
Citation Excerpt :
Time spent on performing the test was measured (Maden-Wilkinson et al., 2015). Aerobic capacity was assessed with six-minute walk test (6MWT) (McPhee et al., 2013; Vilaça et al., 2014). The test was performed on a 20 m circuit and participants were instructed to walk as fast as they could, to cover the maximal distance possible within 6 min.
Older adults have twice as many disabilities and four times as many physical limitations as people <60 years of age. Positive influence of physical activity to prevent these limitations has been presented in some studies. However, the indispensable combination of physical abilities and body composition parameters to maintain independence in later life and their relationship with physical activity has not been studied thoroughly.
The main aim of this study was to determine possible differences in body composition and mobility parameters among older women with various levels of engagement in physical activity. In addition, the relationships between mobility and distinct levels of physical activity were evaluated in healthy older women.
Eighty-one healthy older women aged from 65 to 91 years participated in this study and were allocated to three groups according to weekly moderate-to-vigorous physical activity (MVPA) time in 10 min bouts: highest MVPA (H-MVPA) (n = 27), middle MVPA (M-MVPA) (n = 40) and lowest MVPA (L-MVPA) (n = 14). Body composition (fat mass [FM] and fat free mass [FFM]) variables were assessed with dual-energy X-ray absorptiometry (DXA), objective physical activity data were collected with accelerometers and mobility tests were carried out to assess static and dynamic balance, lower limbs strength and aerobic capacity.
No differences in body composition parameters were observed between studied groups (p > 0.0025). Women in L-MVPA covered significantly shorter distance during the six-minute walk test (6MWT) compared to H-MVPA (p = 0.000) and M-MVPA (p = 0.003) groups, performed timed-up-and-go (TUG) slower compared to H-MVPA group (p = 0.003) and five-times-sit-to-stand (FTSTS) test slower compared to H-MVPA (p = 0.006) and M-MVPA (p = 0.009) groups. There were no differences in body composition and mobility parameters between women in H-MVPA and M-MVPA groups. Regardless of bout duration, MVPA was correlated with mobility (TUG r = −0.47; FTSTS r = −0.37; 6MWT r = 0.53) parameters, whereas no relationships was observed with light physical activity (LPA).
MVPA is associated with body composition and mobility parameters, while LPA is not related to any measured body composition nor mobility parameters. Accordingly, healthy older women could benefit from MVPA to maintain body composition and mobility parameters to preserve independence in later life.
Association of nutrition and immune-endocrine dysfunction with muscle mass and performance in cognitively impaired older adults
2018, Archives of Gerontology and Geriatrics
Citation Excerpt :
Of significance within our study is the lower fat mass in the pre-sarcopenic group, with correspondingly lowest percentage body fat, that highlights the potential for a detrimental effect of adiposity on muscle quality. The relationship between adiposity and muscle quality is further clarified in a recent study reporting poorer muscle quality and physical performance in obese women despite a greater quantity of fat free and lean mass (Vilaca et al., 2014). In parallel with earlier evidence that gender differences may exist in muscle quality measures (Frontera, Hughes, Lutz, & Evans, 1991), men were more likely to exhibit preserved physical performance despite loss of muscle mass (pre-sarcopenia).
With lean mass declining early in Alzheimer’s disease, muscle quality beyond quantity is relevant to physical performance. We sought to identify potentially modifiable factors for the differential loss of muscle mass (pre-sarcopenia) and its performance (sarcopenia) in older adults with mild cognitive impairment (MCI) and mild-to-moderate Alzheimer’s disease (AD).
This is a cross-sectional study of 108 community-dwelling older adults with MCI and mild-to-moderate AD. Participants were categorized as: (i) No sarcopenia (normal muscle mass), (ii) Pre-sarcopenia (low muscle mass without weakness or slowness), (iii) Sarcopenia (low muscle mass AND weak grip strength and/or slow gait speed) using Asian cut-offs. Muscle quality was defined as the ratio of grip and knee extension strength to average arm and leg lean mass respectively. We measured cognitive, functional and physical (Short Physical Performance Battery, SPPB) performance; physical activity level; nutritional status; and blood biomarkers of inflammation and endocrine dysfunction.
SPPB (p = 0.033) and activity level (p = 0.010) were highest in the pre-sarcopenic group. Pre-sarcopenic group had highest arm muscle quality [10.6 (7.7–12.2) vs 13.9 (12.6–15.7) vs 11.3 (9.7–12.8), p < 0.001], despite significantly lower appendicular lean mass than non-sarcopenic group. In multi-nomial logistic regression reference to non-sarcopenic group, malnutrition independently increased risk for both pre-sarcopenia (Relative risk = 7.53, 95% C.I 1.20–47.51, p = 0.032) and sarcopenia (Relative risk = 11.91, 95% C.I 2.85–49.77, p = 0.001). A combined pro-inflammatory and endocrine deficient state significantly increased the risk of sarcopenia (Relative risk = 5.17, 95% C.I 1.31–20.37, p = 0.019).
Malnutrition is a precursor for progressive loss of muscle mass, but a pro-inflammatory and endocrine deficient state may potentially aggravate decline in muscle quality to culminate in frank sarcopenia.

View all citing articles on Scopus

View full text

Body composition, physical performance and muscle quality of active elderly women

Abstract

Introduction

Section snippets

Study design, recruitment and participants

Results

Discussion

Author contributions

Conflict of interest statement

Acknowledgment

Journal of Nutrition, Health and Aging

Chest

American Journal of Clinical Nutrition

Journal of Nutrition Health and Aging

Guidelines for the six-minute walk test

American Journal of Respiratory and Critical Care Medicine

Muscle quality as a potential explanation of the metabolically healthy but obese and sarcopenic obese paradoxes

Metabolic Syndrome and Related Disorders

Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly

Obesity Research

Changes in objective and self-reported measures of physical capacity after an intervention in obese older women

Journal of Women and Aging

Sarcopenia ≠ Dynapenia

Journals of Gerontology. Series A, Biological Sciences and Medical Sciences

International physical activity questionnaire: 12 country reliability and validity

Medicine and Science in Sports and Exercise

Functional impact of relative versus absolute sarcopenia in healthy older women

Journal of the American Geriatrics Society

Grip strength

A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women

Journal of Applied Physiology